国际标准化比值不同分层的慢加急性肝衰竭患者行人工肝治疗的预后及不良反应观察

Prognosis and adverse reactions of patients with acute-on-chronic liver failure receiving artificial liver support therapy stratified by international normalized ratio

目的 观察不同国际标准化比值(INR)水平的慢加急性肝衰竭(ACLF)患者人工肝治疗的预后及不良反应。方法 选取2010年1月—2020年5月于南昌市第九医院重症肝病科行人工肝治疗的ACLF患者共515例,根据INR水平将其分为6组:A组(INR<1.5)20例,B组(1.5≤INR<1.9)115例,C组(1.9≤INR<2.6)179例,D组(2.6≤INR<3.2)61例,E组(3.2≤INR<4.2)75例,F组(INR≥4.2)65例。所有患者均经内科综合治疗联合人工肝治疗。计量资料多组间采用方差分析或Kruskal-Wallis H检验,计数资料多组间比较采用χ^(2)检验,进一步两两比较均采用Bonferroni校正法。通过受试者工作特征曲线评估INR及MELD评分系统对ACLF患者预后的预测价值。结果 INR不同分层ACLF患者90 d病死率比较差异有统计学意义(χ^(2)=124.84,P<0.001),其中A组(25.0%)、B组(25.2%)、C组(39.7%)之间病死率差异无统计学意义(P>0.05);D组(65.6%)、E组(82.7%)、F组(92.3%)与A、B、C组病死率比较,差异均有统计学意义(P值均<0.05);D组与E组患者病死率差异无统计学意义(P>0.05);D组与F组病死率差异有统计学意义(P<0.05);E组与F组病死率差异无统计学意义(P>0.05)。6组间人工肝术中不良反应的发生率差异无统计学意义(χ^(2)=8.956,P=0.111)。INR预测人工肝治疗ACLF患者预后的曲线下面积为0.786(95%CI:0.746~0.825,P<0.001),敏感度、特异度分别为66.7%、79.8%。结论 INR对ACLF患者行人工肝治疗的预后具有较好的预测价值,人工肝安全性良好。

Objective To investigate the prognosis and adverse reactions of patients with acute-on-chronic liver failure(ACLF) receiving artificial liver support therapy stratified by international normalized ratio(INR).Methods A total of 515 ACLF patients who received artificial liver support therapy in Department of Severe liver Disease,The Ninth Hospital of Nanchang,from January 2010 to May 2020 were enrolled,and according to the level of INR,they were divided into group A with 20 patients(INR<1.5),group B with 115 patients(1.5≤INR<1.9),group C with 179 patients(1.9≤INR<2.6),group D with 61 patients(2.6≤INR<3.2),group E with 75 patients(3.2≤INR<4.2),and group F with 65 patients(INR≥4.2).All patients received multimodality medical treatment combined with artificial liver support therapy.The one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups.The chi-square test was used for comparison of categorical data between groups.Bonferroni correction was used for further comparison between two groups.and the receiver operating characteristic(ROC) curve was used to evaluate the value of INR and MELD scoring system in predicting the prognosis of ACLF patients.Results As for 90-day mortality rate,there was a significant difference between the six groups stratified by INR(χ^(2)=124.84,P<0.001);there was no significant difference between groups A(25%),B(25.2%),and C(39.7%)(P>0.05),and there was a significant difference between groups D/E/F(65.6%,82.7%,and 92.3%,respectively) and groups A/B/C(all P<0.05);there was no significant difference between groups D and E and between groups E and F(P>0.05),and there was a significant difference between groups D and F(P<0.05).There was no significant difference in the incidence rate of intraoperative adverse reactions between the six groups(χ^(2)=8.956,P=0.111).INR had an area under the ROC curve of 0.786(95% confidence interval:0.746-0.825,P<0.001) in predicting the prognosis of patients with ACLF receiving artificial liver support therapy,with a sensitivity of 66.7% and a specificity of 79.8%.Conclusion INR has a good value in predicting the prognosis of ACLF patients receiving artificial liver support therapy,and the artificial liver has good safety.